Pastes
Question:
I have an ostomy and have been using tube paste for years. Recently someone told me about strip paste. Is this paste better than what I am currently using?
Answer:
Pastes for ostomy care come under the general category of accessories, which are products that you may or may not need for routine care of your ostomy. Paste is like caulking, filling in gaps and providing a barrier to effluent. It is not the glue that provides the tack or adhesion for your pouching system. Paste is generally used with traditional barriers or pouching systems when the opening of the flange is 1/8 inch (3-4mm) larger than the base of the stoma. The paste fills this gap, acting as an additional barrier to the stool. Paste can also fill in small creases or dips in the skin around the stoma, preventing leaks or undermining of stool under the barrier. All pastes can be in direct contact with the stoma and will not cause harm. Different pastes have different characteristics, so selecting the style of paste you might need, depends on understanding their features and how these might benefit you.
Tube paste is the most common form of paste and all of the major ostomy supply companies in Canada offer this product. Typically, it comes in 2oz (57g) tubes, providing multiple doses or applications if properly used. Tube paste contains alcohol, which provides its smooth, toothpaste-like consistency. There is limited capacity of the paste to absorb moisture from the stool, allowing it to temporarily swell and improve the barrier. However, over time with the repeated exposure to stool, the paste will erode or wash away. Of all the pastes available, tube paste is the least resistant to effluent. Using tube paste requires some dexterity, as you must have enough hand strength to squeeze the tube and properly apply the paste to the surface of the flange. It is also important to quickly re-cap the tube, as exposure to air will allow the alcohol in the paste to evaporate, hardening the product and rendering it ineffective. Depending upon the frequency of your appliance changes, a typical tube of paste will last 1-2 months. If you have broken skin around the stoma, the alcohol will cause temporary burning during application. If you develop redness, itchiness, or blisters directly under the paste, you may have a sensitivity or allergy to the paste and will require a different product.
An alternate form of paste is strip paste. This product contains no alcohol and comes in pre-measured strips. Depending upon your needs (usually the size of the stoma), you can use either whole strips or pieces of a strip. If only portions of a single strip are required, you can leave the remaining piece open to air without concerns of it drying out or hardening. It is an easier product to manipulate, as you can simply roll it between the palms of your hands and form it into a circle/oval to match the opening of your flange. Despite the manipulation, it will retain its tack prior to application. It is a denser product and, as a result, has more resistance to washout with repeated exposure to stool. As there is no alcohol, you can use it with comfort over broken skin or when you suspect sensitivity or allergy to tube paste. Only Coloplast and ConvaTec make strip pastes.
Another option is a barrier ring. While technically not paste, these rings are accessories that provide similar functions to paste: filling in dips, creases, or gaps. Sold as pre-formed rings with a hole in the centre, you gently stretch the product to fit the shape of your stoma and then apply it onto the back of the flange. Pieces of the ring can be torn and molded to fill in creases or gaps. Both sides of the ring have tack and, like strip paste, retain the tack even with manipulation. Barrier rings do not contain alcohol, have even more density than tube or strip paste, and are more resistant to erosion. Despite these positive features, the rings are significantly more expensive than either tube or strip paste. ConvaTec, Coloplast, and Hollister all carry barrier rings.
Determining the right paste or barrier ring for you depends on many factors. In general, paste is recommended for those who have an ileostomy using a traditional barrier. If you have a colostomy with consistently thick stool, you likely don’t require the use of any paste or ring. If you are using the newer moldable technologies as a barrier/flange, then these products will hug your stoma and you may not require the use of paste or rings. If you suspect you are sensitive to the alcohol component of the tube paste, or find the manipulation of a tube cumbersome, then strip paste or barrier rings may be a better option for you. Your ET can help you to determine if any paste or barrier rings are required for your care and the most appropriate formulation.
